Consent and Acknowledgements:
Accuracy of Information: I confirm that all personal and Medicare eligibility information provided, including my Medicare Part A and Part B start dates, is accurate to the best of my knowledge. This information will be used to evaluate and discuss Medicare plan options in compliance with CMS guidelines.
Consent to Collect Medicare Claim ID: I consent to provide my Medicare Claim ID for the purpose of verifying eligibility and enrolling in the best Medicare plans available. I understand that my Medicare Claim ID will be handled securely and in compliance with HIPAA and CMS regulations.
Agent of Record Consent: I appoint the undersigned agent as my authorized representative for matters related to Medicare insurance, including enrollment and policy changes. I understand I can revoke or modify this consent at any time.
Scope of Appointment (SOA) Consent: I consent to discuss specific Medicare plans, adhering to the 48-hour SOA rule, and understand this consent is valid for 12 months unless revoked or modified earlier.
Call Recording Consent: I acknowledge that calls related to marketing, sales, and enrollment may be recorded for compliance and quality assurance.
Data Protection and Privacy: My personal and Medicare-related data, including my Medicare Claim ID, will be treated confidentially and in compliance with applicable privacy laws. The uploaded documents will be encrypted and securely stored, and access will be restricted to authorized personnel only.
Voluntary Participation and Right to Modify or Revoke Consent: I affirm that my participation is voluntary and I retain the right to modify or revoke this consent at any time. I understand that I can request the deletion of my uploaded documents at any time.
Financial Acknowledgement: I understand that there may be costs associated with certain Medicare plans and that these costs vary based on the plan selected.
No Misleading Influences: I confirm that my decision to discuss or enroll in a plan is not influenced by any misleading advertisements or promises.
Understanding of Enrollment Implications: I understand the implications of enrollment decisions on my current coverage will be clearly explained to me.
Health Equity and Accessibility: I acknowledge efforts to provide equitable healthcare services, including appropriate language access services and culturally competent healthcare options.
Consent to Upload Documents: I consent to upload my Medicare card for the purpose of verifying my eligibility. I understand that my documents will be handled securely and in compliance with HIPAA and CMS regulations.
By providing my documents and information, I agree to the terms and conditions provided by the company and acknowledge that my data will be protected according to HIPAA and CMS regulations.